Cut when giving birth
Episiotomy | Johns Hopkins Medicine
What is an episiotomy?
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
Normally, once the baby's head is seen, your healthcare provider will ease your baby's head and chin out of your vagina. Once the baby's head is out, the shoulders and the rest of the body follow.
Sometimes the vaginal opening does not stretch enough for the baby's head. In this case, an episiotomy aids your healthcare provider in delivering your baby. It's important to make a surgical incision rather than letting the tissue tear. Your provider will usually do an episiotomy when the baby's head has stretched your vaginal opening to several centimeters.
Once you deliver the placenta, your healthcare provider will stitch the cut. If you don't have an epidural, your provider may inject a numbing medicine into the perineum. This will numb it before the provider repairs the episiotomy.
Why might I need an episiotomy?
Not all women need an episiotomy. Stretching the tissues naturally may help reduce your need for it. Ask your healthcare provider about how to do this on your own. Without an episiotomy, your perineal tissues may tear. This can be harder to repair.
Your provider may advise an episiotomy in these situations:
- The baby does not have enough oxygen (fetal distress)
- Complicated birth, such as when the baby is positioned bottom or feet first (breech) or when the baby's shoulders are trapped (shoulder dystocia)
- Long pushing stage of labor
- Forceps or vacuum delivery
- Large baby
- Preterm baby
Your healthcare provider may have other reasons to recommend an episiotomy.
What are the risks of an episiotomy?
Some possible complications of an episiotomy may include:
- Bleeding
- Tearing into the rectal tissues and anal sphincter muscle which controls the passing of stool
- Swelling
- Infection
- Collection of blood in the perineal tissues
- Pain during sex
You may have other risks based on your condition.
Be sure to discuss any concerns with your healthcare provider before the delivery.
How do I get ready for an episiotomy?
- Your healthcare provider will explain the procedure and you can ask questions.
- You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear. The form may be part of the general consent for your delivery.
- Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.
- Tell your healthcare provider of all medicines (prescribed and over-the-counter), vitamins, herbs, and supplements that you are taking.
- Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before labor.
- Follow any other instructions your provider gives you to get ready.
What happens during an episiotomy?
Your healthcare provider may do an episiotomy as part of your vaginal birth. The procedure and the type of episiotomy may vary based on your condition and your healthcare provider's practices.
Generally, an episiotomy follows this process:
- You will lie on a labor bed, with your feet and legs supported for the birth.
- If you have not been given any anesthesia, your provider will inject a local anesthetic into the perineal skin and muscle. This will numb the tissues before the incision is made. If epidural anesthesia is used, you will have no feeling from your waist down. In this case, you won't need more anesthesia for the episiotomy.
- During the second stage of labor (pushing stage), as your baby's head stretches your vaginal opening, your healthcare provider will use surgical scissors or a scalpel to make the episiotomy incision
- Your provider will deliver your baby followed by the placenta.
- He or she will check the incision for any further tearing.
- Your provider will use stitches (sutures) to repair the perineal tissues and muscle. The stitches will dissolve over time.
What happens after an episiotomy?
After an episiotomy, you may have pain at the incision site. An ice pack may help reduce swelling and pain. Warm or cold shallow baths (sitz baths) may ease soreness and speed healing. Medicated creams or local numbing sprays may also be helpful.
You may take a pain reliever as recommended by your doctor. Be sure to take only recommended medicines.
Keep the incision clean and dry using the method your healthcare provider recommends. This is important after urination and bowel movements. If bowel movements are painful, stool softeners recommended by your healthcare provider may be helpful.
Do not douche, use tampons, or have sex until your healthcare provider says it's OK. You may also have other limits on your activity, including no strenuous activity or heavy lifting.
You may go back to your normal diet unless your healthcare provider tells you otherwise.
Your healthcare provider will tell you when to return for further treatment or care.
Tell your healthcare provider if you have any of the following:
- Bleeding from the episiotomy site
- Foul-smelling vaginal drainage
- Fever or chills
- Severe perineal pain
Your healthcare provider may give you other instructions after the procedure, based on your situation.
Next steps
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person's qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
Episiotomy and perineal tears - NHS
Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth.
This is called an episiotomy.
An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
Sometimes a woman's perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.
If your doctor or midwife feels you need an episiotomy when you're in labour, they will discuss this with you. In England, episiotomies are not done routinely.
Non-urgent advice: Call your midwife or GP if you've had an episiotomy or tear and:
- your stitches get more painful
- there's smelly discharge
- there's red, swollen skin around the cut (incision) or tear – you can use a mirror to have a look
Any of these may mean you have an infection.
Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.
The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy might be done if:
- the baby is in distress and needs to be born quickly, or
- there is a need for forceps or vacuum (ventouse), or
- there is a risk of a tear to the anus
Around 1 in 7 deliveries in England involves an episiotomy.
If you have a tear or an episiotomy, you'll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.
Why you might need an episiotomy
An episiotomy may be recommended if your baby develops a condition known as foetal distress, where the baby's heart rate gets faster or slower before birth.
This means your baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth injuries or stillbirth.
Another reason for an episiotomy is because it's necessary to widen your vagina so instruments, such as forceps or ventouse suction, can be used to help with the birth.
This may be necessary if:
- you're having a breech birth, where the baby is being born with their bottom or feet first
- you have been trying to give birth for several hours and are now tired after pushing
- you have a serious health condition, such as heart disease and it's recommended that delivery should be as quick as possible to reduce further health risks
Research shows that in some births, particularly with forceps deliveries, an episiotomy may prevent tears that affect the anal muscle (third-degree tears).
How an episiotomy is done
An episiotomy is usually a simple procedure. A local anaesthetic is used to numb the area around the vagina so you do not feel any pain. If you have already had an epidural, the dose can be topped up before the cut is made.
Whenever possible, the doctor or midwife will make a small diagonal cut from the back of the vagina, directed down and out to one side. The cut is stitched together using dissolvable stitches after the birth.
Recovering from an episiotomy
Episiotomy cuts are usually repaired within an hour of your baby's birth. The cut may bleed quite a lot at first, but this should stop with pressure and stitches.
Stitches should heal within 1 month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period.
Coping with pain
It's common to feel some pain after an episiotomy.
Painkillers such as paracetamol can help relieve pain and is safe to use if you're breastfeeding.
It's also thought to be safe to take ibuprofen while you're breastfeeding, but check with your doctor first.
Aspirin is not recommended as it can be passed on to your baby through your breast milk. Your midwife will advise you if you're not sure what painkillers to take.
It may be necessary to treat severe pain with stronger prescription-only painkillers, such as codeine.
However, prescription-only medicine may affect your ability to breastfeed safely. Your GP or midwife can advise you about this.
To ease the pain, try:
- placing an ice pack or ice cubes wrapped in a towel on the cut.
Avoid placing ice directly on your skin as this could cause damage
Exposing the stitches to fresh air can help the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help.
It's unusual for pain after an episiotomy to last longer than 2 to 3 weeks. If the pain lasts longer than this, speak to a doctor, health visitor, or another health professional.
Going to the toilet
Keep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour warm water over your vaginal area to rinse it.
Pouring warm water over the outer area of your vagina as you pee may also help ease the discomfort.
You may find squatting over the toilet, rather than sitting on it, reduces the stinging sensation when peeing.
When you're pooing, you may find it useful to place a clean pad on the cut and press gently.
This can help relieve pressure on the cut.
When wiping your bottom, make sure you wipe gently from front to back. This will help prevent bacteria in your anus infecting the cut and surrounding tissue.
If you find pooing is particularly painful, taking laxatives may help. This type of medicine is usually used to treat constipation and makes poo softer and easier to pass.
For more information, read about treating constipation.
Pain during sex
There are no rules about when to start having sex again after you've given birth.
In the weeks after giving birth, many women feel sore as well as tired, whether they've had an episiotomy or not. Do not rush into it. If sex hurts, it will not be pleasurable.
If you've had a tear or an episiotomy, pain during sex is very common in the first few months.
If penetration is painful, say so. If you pretend everything is OK when it is not, you may start to see sex as a nuisance rather than a pleasure, which will not help you or your partner.
You can still be close without having penetration – for example, through mutual masturbation.
Pain can sometimes be linked to vaginal dryness. You can try using a water-based lubricant available from pharmacies to help.
Do not use an oil-based lubricant, such as Vaseline or moisturising lotion, as this can irritate the vagina and damage latex condoms or diaphragms.
You can get pregnant just 3 weeks after the birth of a baby, even if you're breastfeeding and your periods have not started again.
Use some kind of contraception every time you have sex after giving birth, including the first time (unless you want to get pregnant again).
You'll usually have an opportunity to discuss your contraceptive options before you leave hospital (if you've had your baby in hospital) and at the postnatal check.
You can also talk to a GP, midwife or health visitor, or go to a contraception clinic at any time.
Find sexual health services near you.
Infection
Look out for any signs that the cut or surrounding tissue has become infected, such as:
- red, swollen skin
- discharge of pus or liquid from the cut
- persistent pain
- an unusual smell
Tell a GP, midwife or health visitor as soon as you can about any possible signs of infection so they can make sure you get the treatment you might need.
Exercises
Strengthening the muscles around the vagina and anus by doing pelvic floor exercises can help with healing and will reduce the pressure on the cut and surrounding tissue.
Pelvic floor exercises involve squeezing the muscles around your vagina and anus as though to stop yourself from going to the toilet or farting.
A midwife can explain how to do the exercises. You can also read more about pelvic floor exercises on our page about exercise in pregnancy.
Scar tissue
For a few women, excessive, raised or itchy scar tissue forms around the place where a tear happened or where an episiotomy was done. If your scar tissue is causing problems for you, tell your doctor.
Preventing a perineal tear
A midwife can help you avoid a tear during labour when the baby's head becomes visible.
The midwife will ask you to stop pushing and to pant or puff a couple of quick short breaths, blowing out through your mouth.
This is so your baby's head can emerge slowly and gently, giving the skin and muscles of the perineum time to stretch without tearing.
The skin of the perineum usually stretches well, but it may tear, especially in women who are giving birth for the first time.
Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth.
The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.
The most benefit was in women who repeated this every day.
Early or late cord cutting: which is better for the baby's health
Later performed after the first minute or after the end of the umbilical cord pulse. The difference, at first glance, is not significant, but within the first minute after birth, 80 ml of blood enters the child through the umbilical cord, and by the third minute - 100 ml, which gives the child 40-50 mg / kg of iron.
To avoid excess blood flow to the fetus due to uterine contractions, doctors may delay administering uterine contractions until the umbilical cord is cut. nine0003
Why do doctors resort to early cord cutting?
In most maternity hospitals, it is customary to clamp and cut off the umbilical cord immediately after the baby is born. This procedure is quite familiar and natural. The newborn is then usually taken away for examination. As a rule, this is a tribute to an established tradition.
Which cord cutting is recommended by WHO experts?
The World Health Organization (WHO) recommends cutting the umbilical cord after the pulsation has stopped or even after the placenta has passed. It is beneficial for both the child and the mother. This is the natural course of childbirth, conceived by nature. I recommend that women always discuss late cord cutting with their doctor, unless there is a contraindication to doing so. nine0003
What arguments do doctors put forward in favor of late suppression?
Thanks to the umbilical cord, placental blood flows to the baby after birth.
It contains substances that naturally enhance the child's immunity, as well as iron, hemoglobin and other important trace elements. And if it is cut off a few minutes after birth, and not immediately after the baby is born, it will benefit his health.
We must not forget that our biological species belongs to the class of mammals. Reproductive processes have certain similarities within our biological class. nine0003
And if we look at our younger brothers, we will see that none of them is in a hurry to cut the umbilical cord immediately after the birth of the cub. The process goes slowly and gradually, and when the mother gnaws through the umbilical cord, it is already completely empty, so that when the vessels are crossed, not a drop of blood is released from them.
What are the advantages of a late crossing?
• Saturation with useful trace elements
If clipping and cutting the umbilical cord not immediately after birth, but after 1-3 minutes, this will increase the level of iron and hemoglobin in the blood of the fetus.
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• Prevention of anemia
The most common condition seen in children with early cord cutting is anemia. As you know, caesarean section makes it impossible to cut the umbilical cord later. That is why anemia in babies after CS is much more common than after natural childbirth.
• Easy birth of the placenta
There is another argument in favor of a late cord cutting. Due to this, the placenta emptied of blood decreases in volume and the birth of the placenta is easier. nine0003
• The unique composition of blood
The umbilical cord contains blood, which is a unique source of stem cells. It is used to treat deadly diseases. An increase in the number of stem cells in the human body triggers an intensive restoration of diseased organs and damaged tissues. This happens due to regeneration: healthy cells are formed in place of the lost cells.
For a newborn it is even more valuable, so it is necessary to discuss with the midwife and doctor even before the start of labor whether, in the absence of contraindications, the umbilical cord can be cut only after the pulsation has stopped.
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When is rapid cord cutting required?
As with any rule, there are exceptions to this as well. There are only three factors in which the umbilical cord must be cut quickly:
• Threat of Rhesus conflict
• Tight entanglement
• Acute hypoxia
These situations are dangerous for the life and health of the baby. So, with tight entanglement and acute hypoxia, the central nervous system suffers, and oxygen deficiency can cause disorders: neurological disorders, mental retardation. In other cases, if the condition of the infant allows, later cord cutting is recommended. nine0003
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How to properly deliver a dog?
In order for a dog to give birth safely, its owners need to properly prepare for this event. In some cases, it is not necessary to take her to a veterinary clinic - childbirth at home is also acceptable.
How long does a dog's pregnancy last?
The average duration of a dog's pregnancy is approximately 58-68 days. Some babies are born on the 70-72nd day. It depends on the physiological characteristics of the female. Small breed dogs can carry puppies for 56–60 days, medium breed dogs for 60–66 days, and large dogs for 64–70 days. nine0003
Is it true that dogs always give birth without problems?
Owners should always be prepared for any contingency during childbirth. If the dog's pregnancy is normal and the puppies are developing correctly, then this is called a physiological pregnancy, while an abnormal pregnancy indicates problems in the pregnant dog or developing puppies. Symptoms of pathological pregnancy may include: fever, loss of appetite, vaginal discharge, lethargy, and more. All these symptoms are a serious reason to consult a veterinarian. Experts also distinguish a false pregnancy, in which the dog shows all the signs of pregnancy, but there is no pregnancy itself.
False pregnancy may be the result of a disturbed hormonal background in a dog. Usually these symptoms disappear after a couple of weeks without any treatment, but to confirm this diagnosis, it is necessary to take the dog to the veterinarian. nine0003
How does the complexity of childbirth depend on the breed of the dog?
The course of childbirth in dogs can be influenced by their physiological characteristics. Quite often, dogs give birth naturally without the help of a veterinarian. But his presence is desirable, for example, if large puppies are expected.
Indications for medical assistance may be:
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weak contractions and attempts or their absence;
-
intrauterine fetal death; nine0003
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dystocia — impossibility of passing fetuses through the birth canal of a female;
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fetal development disorder.
Complications can occur in large breeds such as Shepherds, Labradors, Great Danes, St.
Bernards, Bullmastiffs. As a rule, they give birth to a small number of puppies. Dogs of brachycephalic breeds also fall into the risk zone: pugs, English and French bulldogs due to the peculiarities of their respiratory system. Also, one of the serious indications for caesarean section is the discrepancy between the large head of the puppy and the birth canal of the dog-mother. nine0061
How does a dog's behavior change before giving birth?
A few days before giving birth, the dog's belly drops. She becomes restless, “digs” the floor, demands affection or looks for a nest, may refuse food or, conversely, demand it. The temperature before childbirth drops to 36.5-37 degrees.
What to prepare for childbirth?
A pregnant dog will need a secluded place in the house where she can give birth to puppies. For this, a large box or playpen is suitable, where you can put her favorite toys, clean bedding and diapers. Before the onset of childbirth you will need:
clean towels or sheets;
- heating pad;
- brilliant green or iodine;
- hand sanitizer;
- separate box for puppies;
- baby scale;
- sterilized clean scissors and sterile threads
It is essential to have the telephone number of the veterinarian on hand in case of force majeure.
How to take delivery? In what cases do people need help? nine0061
The owner should be aware of how long the birth of a dog lasts. The female gives birth on average 3-12 hours. You are welcome to adopt puppies if possible. It is necessary to release the puppy from the amniotic sac, tie the umbilical cord with a thread, cut it, treat the wound with brilliant green, gently and carefully wipe the puppy with dry gauze or a towel, it is especially important to remove the mucus from the nose and mouth, and then put the puppy next to the mother dog so that it starts eat colostrum. In most cases, dogs are quite independent and your participation will be required only in emergency situations. nine0003
When do you need to see a veterinarian urgently?
Call your veterinarian immediately if you develop foul-smelling purulent or bloody discharge, if your temperature rises above 40°C, if your dog is in labor for more than 12 hours, or if you notice other symptoms that bother you or your dog.
Postpartum period
Immediately after birth, the dog produces milk, or rather, colostrum. You need to make sure that the puppies actively sucked their mother. Dogs during lactation (when they feed puppies with milk) require more energy, calcium and other nutrients - it is best to choose a balanced high-quality diet for your pet during this period. The most important thing that a newly-made dog family needs is warmth and silence. In the first two or three weeks, the mother will devote almost all her time and attention to the babies in order to lick each of them, cleaning the fur, and feed. nine0003
How long after giving birth will a dog go into heat again?
The start of a new estrus in a female depends on her individual cycle. On average, estrus can occur 8-9 months after birth. It lasts approximately 30 days.
If you wish to neuter your dog after the birth of puppies, be sure to consult your veterinarian about all pre-procedures and the best timing for this operation.
